By Mary Agnes Carey, CQ HealthBeat Associate Editor
September 20, 2006 -- A "scorecard" of the nation's health care system released Wednesday gave the United States an average of 66 out of a possible 100 on a series of health quality measures, with those shortcomings costing as many as 150,000 lives and $100 billion annually.
The report, compiled by the nonpartisan Commonwealth Fund's Commission on a High Performance Health System, found that the United States was not the top scorer in any of the 11 international indicators of health outcomes, quality, access, equity, and efficiency, despite the fact that Americans spend more on their medical care than citizens in Germany, Canada, France, Australia, or the United Kingdom.
"You can run but you cannot hide from these massive statistics presented today," commission chairman James J. Mongan said at a news conference.
Commonwealth Fund President Karen Davis said the data demonstrates that "we are not getting good value for that investment," while Senior Vice President Cathy Schoen said the results present "significant missed opportunities to do better."
The United States does a poor job with medical care at birth—ranking last among industrialized countries on infant mortality—and at the end of life as well, the report found. The United States ranks 15th out of 19 countries in deaths potentially preventable with timely and effective medical care. According to the report, 115 people per 100,000 Americans die of illnesses amenable to medical care before age 75, compared with 75 to 84 per 100,000 in the top three countries.
Overuse and waste of medical services, coupled with poor access and variations in cost and quality of care, gave the United States a score of 51 on efficiency. Other problems cited in that category include the fact that the United States is far behind other countries in the use of electronic medical records, wide variances in 30-day hospital readmission rates, and high insurance administrative costs. "We have very high overhead costs to run our insurance system," Schoen said.
Mohit Ghose, a spokesman for America's Health Insurance Plans, a trade group representing health insurers, said recent studies have shown that health insurance plan "administrative expenses" include expenditures for value-added services that are working to improve the quality and affordability of health care services. Those services include prevention, disease management, care coordination, investments in health information technologies and health support, and provider support, Ghose said.
On quality, the United States scored 71, in part because only half of adults received preventative and screening tests according to guidelines for their age and sex. While 87 percent of the nation's top-performing hospitals give heart failure patients written instructions and educational materials at discharge, only 9 percent of the lowest-performing hospitals do so.
On access, the United States scored 67, due to the nation's high uninsured rate and the fact that one-third of adults under age 65 have problems paying their medical bills or have medical debt they are paying off over time.
To develop the scorecard, Commonwealth researchers used the Institute of Medicine's framework for quality of care and drew on 37 indicators developed by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, the National Committee for Quality Assurance, and other experts.
The findings were published Wednesday as a Web Exclusive in the journal Health Affairs.
